Crown Life Insurance v. Commonwealth

394 A.2d 1305, 39 Pa. Commw. 94, 1978 Pa. Commw. LEXIS 1481
CourtCommonwealth Court of Pennsylvania
DecidedDecember 7, 1978
DocketAppeal, No. 1141 C.D. 1977
StatusPublished
Cited by4 cases

This text of 394 A.2d 1305 (Crown Life Insurance v. Commonwealth) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Crown Life Insurance v. Commonwealth, 394 A.2d 1305, 39 Pa. Commw. 94, 1978 Pa. Commw. LEXIS 1481 (Pa. Ct. App. 1978).

Opinion

Opinion by

Judge Craig,

Section 354 of The Insurance Company Law of 1921, Act of May 17, 1921, P.L. 62, as amended, 40 P.S. §477b empowers the Insurance Commissioner of Pennsylvania (Commissioner) to screen life insurance policy forms and reject or approve them for sale in the Commonwealth.

Accordingly, Crown Life Insurance Company (Crown) submitted its policy form K6005 for approval. The Department of Insurance (Department) denied approval. After a hearing, the Commissioner issued an Order and Adjudication affirming the Department’s rejection. Crown now petitions this Court to review that order.

There is no disagreement over what the policy says or purports to do. The controversy arises over possible consumer misunderstanding of it.

[96]*96The policy is basically a hybrid of the two traditional whole life insurance modes, participating and non-participating.1

' In policy form K6005, Crown sets the initial premium by making a very close assumption for bad experience, similar to the way a rate would be computed for non-participating policies. That approach results in a relatively low, immutable premium charge for the first three years.

However, beginning in the fourth year of coverage, the maximum premium rate is fixed under an assumption that takes into account a “contingency margin” for possible very bad future experience, similar to the way insurers calculate a participating policy rate. This feature could produce a significant jump in the premium amount charged after the initial three years.

[97]*97Importantly, these computations are made in advance, and therefore the' policy clearly reveals that there will be an increased premium beginning in year four.

Were the foregoing the only premium provisions in the policy, it would be a “modified three” whole life policy, with which the Department apparently has no quarrel.

However, the problem arises because Crown plans, if possible, not to charge the maximum premium shown. Instead, after the initial three years of coverage, the insurer will then currently calculate the premium actually needed and charge only the resulting amount. Accordingly, the policy explains to the insured that, beginning in year four, the insurer in any year may adjust the premium downward for that year.

Moreover, in addition to the guaranteed maximum premium stated for the fourth and later years, the actual premium will not be higher than the actuarial equivalent of what it would then currently charge for an orthodox participating whole life plan.

The policy explains these points under the heading “Reduction of Premium Provision.”2

[98]*98The Commissioner finds the reduction of premium provision to be objectionable. For that reason alone, the Commissioner has disapproved the proposed policy form.3

The Commissioner relies solely on the broad, general language of Section 354 of The Insurance Company Law as authority for his disapproval. He asserts that the statute gives him the discretion to make a threshold determination of unsuitability when, in his best judgment, he finds, as a matter of public policy and the best interests of potential policyholders, that the policy in question is not a “fit subject for approval.”

[99]*99In part, Crown counters that, even if Section 354 vests such broad discretion in the Commissioner, he has manifestly abused it by rejecting this policy form.

We need not consider Crown’s other arguments because we are convinced that, even confined to the narrow scope of review delineated by the applicable statute,4 we cannot affirm the Commissioner’s determination.

Our examination of the record consists of two inquiries : (1) whether the findings of fact are supported by substantial evidence; and, if so, (2) whether those facts in turn support the relevant conclusions of law made by the Commissioner. Wallace v. Insurance Department, 18 Pa. Commonwealth Ct. 267, 270, 334 A. 2d 830, 831-32 (1975).

Essentially the Commissioner set forth two related conclusions as supporting his disapproval of the reduction of premium provision: (1) it is impossible for potential purchasers intelligently to estimate the policy’s cost or compare its cost with others; and therefore, (2) its cost can be easily misrepresented.

The core of Crown’s case is that the net cost of this policy is no more unintelligible or unascertainable [100]*100to a prospective policyholder than the net cost of participating policies, which are routinely approved. In both types of policies, the consumer can see a guaranteed maximum potential cash outlay, plus the chance of some reduction either through part of his expenditures being returned to him in the form of a dividend or, as the proposed policy form provides, through the expenditure being lowered by premium reduction. In short, both types of policy forms tell the consumer in black and white what the maximum cost will be, plus the possibility that the cost may be less.

Much of the Department’s testimony relates to the possibility that solicitors selling this policy will convince purchasers to disregard the maximum premium figure. Therefore the Commissioner concludes that the policy can be easily misrepresented.

Common logic requires us to agree with Crown that the Commissioner could as easly visualize potential misrepresentation in the sale of participating policies. As Crown’s brief states, agents could assure customers that dividend projections are conservatively estimated or guaranteed, just as readily as unjustified promises of premium reductions could be made with respect to the policy form in question.

Therefore, unless the Commissioner is prepared to subject participating policy forms to like condemnation, we see no reasonable basis for disapproving this form on the basis of anticipating misrepresentation.

Of great significance is Crown’s uncontradicted evidence that participating life insurance rates have declined over the years, with the result that holders of such policies, seeing current rates drop below the fixed rates in their policies, have been motivated to replace such older policies, but subject to the difficulties and costs that attend such replacement.

[101]*101The Commissioner himself observed that Crown enjoys a good reputation in the insurance field and that his decision might well be different were he to consider whether or not only Crown should be permitted to sell this policy.

The Department’s rebuttal evidence consisted of no more than speculation about possible misrepresentation by some hypothetical unscrupulous agent. Although the Commissioner’s reservations are understandable, they do not rise to the level of fact to rebut Crown’s testimony as to its actual experience with this type of policy.

The conclusion that this policy has a peculiar potential to be misrepresented is dependent upon the conclusion that “it is impossible for a potential purchaser to make an intelligent estimate of . . . likely cost.” Conclusions of Law 3(c) and (d). Both conclusions, in turn, are related to the finding of fact that there exists “no adequate means of price comparison.” Finding of Fact 9.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Komada v. Browne
508 A.2d 1284 (Commonwealth Court of Pennsylvania, 1986)
Fioravanti v. Commonwealth
439 A.2d 1272 (Commonwealth Court of Pennsylvania, 1981)
Travelers Indemnity Co. of America v. Commonwealth
63 Pa. Commw. 542 (Commonwealth Court of Pennsylvania, 1981)
Pennsylvania State Ass'n v. Commonwealth
412 A.2d 675 (Commonwealth Court of Pennsylvania, 1980)

Cite This Page — Counsel Stack

Bluebook (online)
394 A.2d 1305, 39 Pa. Commw. 94, 1978 Pa. Commw. LEXIS 1481, Counsel Stack Legal Research, https://law.counselstack.com/opinion/crown-life-insurance-v-commonwealth-pacommwct-1978.